title: Dysfunctional elimination syndrome is a negative predictor for vesicoureteral reflux.
abstract: OBJECTIVE
  We investigated the likelihood of finding vesicoureteral reflux (VUR) in patients with urinary tract infections (UTIs), accompanied by fever or dysfunctional elimination syndrome (DES).
  
  
  METHODS
  Two hundred consecutive voiding cystourethrograms performed in 1997-2002 for a diagnosis of UTI were reviewed. Fever, DES, and the grade and laterality of VUR were recorded. Patients were stratified into two groups by age to allow for assessment of DES symptoms in the older patient population: <2 years (n=68) and > or =2 years (n=132). Ratios were compared using a two-tailed Fisher's exact test.
  
  
  RESULTS
  Of the children> or =2 years old, 64/132 (48%) had VUR. Patients who were non-febrile with DES were less likely than patients who were febrile without DES to have VUR [12/34 (35%) vs 23/34 (68%), P=0.02], whereas the risk of dilating VUR [5/34 (15%) vs 11/34 (32%), P=0.15] and bilateral VUR [4/34 (12%) vs 11/34 (32%), P=0.08] was not statistically different. In febrile patients, the presence of DES was associated with a lower risk of VUR [22/51 (43%) vs 23/34 (68%), P=0.03] and dilating VUR [5/51 (10%) vs 11/34 (32%), P=0.01], but not bilateral VUR [8/51 (16%) vs 11/34 (32%), P=0.11].
  
  
  CONCLUSIONS
  Children with non-febrile UTI and DES have a significantly lower risk of having VUR compared to children with febrile UTI and no DES. Among children with a history of UTI, DES is a negative predictor for VUR.
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: John
authors.initials: J
authors.lastname: Colen
authors.forename: Steven G
authors.initials: SG
authors.lastname: Docimo
authors.forename: Kate
authors.initials: K
authors.lastname: Stanitski
authors.forename: Danielle D
authors.initials: DD
authors.lastname: Sweeney
authors.forename: Barbara
authors.initials: B
authors.lastname: Wise
authors.forename: Patricia
authors.initials: P
authors.lastname: Brandt
authors.forename: Hsi-Yang
authors.initials: HY
authors.lastname: Wu